I am looking for information about how other facilities who use donated blood products (such as received from ARC) handle billing and coding of irradiated platelets (P9035) in outpatient situations?

Specifically:

Does anyone/everyone use irradiated platelets only?

How do you bill your irradiated platelets, if that is all you have/receive in your inventory, but the ordering physician did not specifically request it for that patient? (No medical necessity)

Do you ever give any non-irradiated PRBCs along with irradiated platelets, in same transfusion event, and if so, how do you bill those?

How do you handle the CCI edit?

Thank you! I appreciate your help!

I'm not sure this is the best way, but when we issue an irradiated blood product (that the physician has ordered), our computer sends a test code to bill for the product and a second test code (CPT 86945) to bill for the irradiation fee.

If we happen to have an irradiated product and need to give it to a regular patient (who does not require irradiated products), we do not charge the patient for the irradiation fee. (In this case, the BB/Lab absorbs the ARC irradiation fee.)

There have been times when a doc has ordered 2 irradiated plateletphereses for a patient, but we only have one irradiated plt available. If the physician decides he can't wait for us to obtain a another irradiated plt, we will issue the irradiated plt and a regular plt. In this case, we would charge for 2 plateletpheresis products and one irradiation fee.

We bill the product which almost always includes the irradiation fee. If we have irradiated product we need to give to a patient that doesn't need irradiation, I request a manual billing adjustment.

There is an interesting discussion on the AABB forum and also the Cal BB society page about irradiation, indication and reimbursement issues:

http://www.cbbsweb.org/enf/2008/irrad_reimb.html

Linda Frederick

Here is the AABB billing reimbursement guide link. They address this question in the guide.

http://www.aabb.org/Documents/Programs_and_Services/Billing_and_Reimbursement_Initiatives/reimbguidev071017.pdf

Hope this helps